Individual and environmental contributions to treatment outcomes following a neuroplasticity-principled speech treatment (LSVT LOUD) in children with dysarthria secondary to cerebral palsy: a case study review.

This study describes the use of a neuroplasticity-principled speech treatment approach (LSVT(®)LOUD) with children who have dysarthria secondary to cerebral palsy. To date, the authors have treated 25 children with mild-to-severe dysarthria, a continuum of gross and fine motor functions, and variable cognitive abilities. From this data set, two case studies are presented that represent as weak or strong responders to LSVT LOUD. These case studies demonstrate how individual and environmental features may impact immediate and lasting responses to treatment. Principles that drive activity-dependent neuroplasticity are embedded in LSVT LOUD and may contribute to positive therapeutic and acoustic outcomes. However, examination of the response patterns indicated that intensity (within and across treatment sessions) is necessary but not sufficient for change. Weak responders may require a longer treatment phase, better timing (e.g., developmentally, socially), and a more prominent desire to communicate successfully during daily activities. Strong responders appear to benefit from the intensity and saliency of treatment as well as from intrinsic and extrinsic rewards for using the trained skills for everyday communication. Finally, possibilities are presented for technological solutions designed to promote accessibility to the intensive task repetition and maintenance required to drive lasting changes.